Healthcare Provider Details

I. General information

NPI: 1528101219
Provider Name (Legal Business Name): BONNIE LOUISE MERRITT PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 FRUITVALE AVE
OAKLAND CA
94601-2322
US

IV. Provider business mailing address

1501 FRUITVALE AVE
OAKLAND CA
94601-2322
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-6200
  • Fax: 510-535-4167
Mailing address:
  • Phone: 510-535-6200
  • Fax: 510-535-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: